Print This Form for Mailing

Complete the Request Form - BLOCK letters please!

Send this printed request form and a STAMPED ADDRESSED envelope and either TWO first class stamp PER REFERENCE or a self addressed envelope (no stamp on!) and $2.00 (US, CAN, AUS, NZ) in currency PER REFERENCE (for copying and mailing costs) to:

Mrs J D Goucher,

ANGLERS REST, GROVE CRESCENT
TEIGNMOUTH, DEVON, TQ14 9HP, ENGLAND

Name:	E-mail:
Address:
City:	Co/Prov/State:
Country:	Postal Code:

Please provide copies of the following newspaper(s) material.

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Signed……………………………………